Provider Demographics
NPI:1922310572
Name:RICHMOND FOOT AND ANKLE INSTITUTE
Entity Type:Organization
Organization Name:RICHMOND FOOT AND ANKLE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEECOST
Authorized Official - Suffix:
Authorized Official - Credentials:MD/DPM/MPH
Authorized Official - Phone:804-643-8667
Mailing Address - Street 1:409 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4220
Mailing Address - Country:US
Mailing Address - Phone:804-643-8667
Mailing Address - Fax:
Practice Address - Street 1:409 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4220
Practice Address - Country:US
Practice Address - Phone:804-643-8667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000319261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9302221Medicaid
VA480000299Medicare PIN
VAVAA101320Medicare PIN